Test
Exam 1 Practice
Este test tiene tipos de pregunta que se abren en el reproductor de siempre.
Preguntas del test (130)
1Four patients in labor all request epidural analgesia to manage their pain at the same time. Which ethical principle is compromised when only one nurse anesthetist is on call?
- AJustice
- BNonmaleficence
- Cbeneficence
- DFidelity
2The patient tells the nurse that she is afraid to speak up regarding her desire to end care for fear of upsetting her husband and children. Which principle in the nursing code of ethics ensures that the nurse will promote the patient’s cause?
- AResponsibility
- Badvocacy
- CConfidentiality
- DAccountability
3The patient’s son requests to view the documentation in his mother’s medical record. What is the nurse’s best response to this request?
- A“I’ll be happy to get that for you.”
- B“You will have to talk to the physician about that.”
- C“You are not allowed to see it.”
- D“You will need your mother’s permission.”
4When people work together to solve ethical dilemmas, individuals must examine their own values. This step is crucial to ensure that
- AThe group identifies the one correct solution
- BFact is separated from opinion.
- CJudgmental attitudes are not provoked.
- DDifferent perspectives are respected.
5Ethical dilemmas are common occurrences when caring for patients. The nurse understands that dilemmas are a result of
- APresence of conflicting values.
- BHierarchical systems.
- CJudgmental perceptions of patients.
- DPoor communication with the patient.
6 The nurse questions a physician’s order to administer a placebo to the patient. The nurse’s action is based on which ethical principle?
- AAutonomy
- BBeneficence
- CJustice
- DFidelity
7The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment?
- ACall for an ethical committee consult.
- BDecline the assignment on religious grounds.
- CScrutinize her own personal values.
- DConvince the family to challenge the directive.
8The nurse values autonomy above all other principles. Which patient assignment will the nurse find most difficult to accept?
- ATeenager in labor who requests epidural anesthesia
- BMiddle-aged father of three with an advance directive declining life support
- CElderly patient who requires dialysis
- DFamily elder who is making the decisions for a 30-year-old female member
9Which philosophy of health care ethics would be particularly useful when making ethical decisions about vulnerable populations?
- AFeminist ethics
- BDeontology
- CBioethics
- DUtilitarianism
10A nurse argues that we need to reform our health care system because we have a large number of people who are uninsured and end up needing expensive emergent care when low-cost measures could have prevented their illnesses. What ethical framework is she using to make this case?
- ADeontology
- BEthics of care
- CFeminist ethics
- DUtilitarianism
11The nurse has become aware of missing narcotics in the patient care area. Which ethical principle obligates the nurse to report the missing medications?
- AAdvocacy
- BResponsibility
- CConfidentiality
- DAccountability
12 A young woman who is pregnant with a fetus exposed to multiple teratogens consents to have her fetus undergo serial PUBS (percutaneous umbilical blood sampling) to examine how exposure affects the fetus over time. Although these tests will not improve the fetus’ outcomes and will expose it to some risks, the information gathered may help infants in the future. Which ethical principle is at greatest risk?
- AAutonomy
- BFidelity
- CNonmaleficence
- DBeneficence
13 Which issue has increased the attention paid to quality of life concerns in recent history?
- AHealth care disparities
- BNational movement regarding disabled persons
- CAging of the population
- DHealth care financial reform
14Which patient is most likely to have difficulty with the ethical concept of autonomy?
- A18-year-old patient in labor
- B35-year-old patient with appendicitis
- C53-year-old patient with pancreatitis
- D78-year-old patient with rheumatoid arthritis
15The nurse is caring for a severely ill patient with AIDS who now requires ventilator support. Which intervention is considered futile?
- AAdministering the influenza vaccine
- BProviding oral care every 5 hours
- CApplying fentanyl patches prn for pain
- DSupporting the patient’s lower extremities with pillows
16During a severe respiratory epidemic, the local health care organizations decide to give health care providers priority access to ventilators over other members of the community who also need that resource. Which philosophy would give the strongest support for this decision?
- AFeminist ethics
- BUtilitarianism
- CDeontology
- DEthics of care
17Determinations regarding quality of life are
- ABased on a person’s ability to act according to ethical principles.
- BBased on a patient’s self-determination.
- CValue judgments that can vary from person to person.
- DConsistent and stable over the course of one’s lifetime.
18The nurse is caring for a patient supported with a ventilator who has been unresponsive since arrival via ambulance 8 days ago. The patient has not been identified, and no family members have been found. The nurse is concerned about the plan of care regarding maintenance or withdrawal of life support measures. The nurse determines that this is an ethical dilemma not resolved by scientific data. Place the steps the nurse will use to resolve this ethical dilemma in the correct order.
[blank_start]a.[blank_end] The nurse identifies possible solutions or actions to resolve the dilemma.
[blank_start]b.[blank_end] The nurse reviews the medical record, including entries by all health care disciplines, to gather information relevant to this patient’s situation.
[blank_start]c.[blank_end] Health care providers use negotiation to redefine the patient’s plan of care.
[blank_start]d.[blank_end] The nurse evaluates the plan and revises it with input from other health care providers as necessary.
[blank_start]e.[blank_end] The nurse arranges a meeting with health care team members to clarify opinions, values, and facts.
[blank_start]f.[blank_end] The nurse states the problem.- A4
- B1
- C5
- D6
- E2
- F3
19A newly hired experienced nurse is preparing to change a patient’s abdominal dressing and hasn’t done it before at this hospital. Which action by the nurse is best?
- AAsk another nurse to do it so the correct method can be viewed.
- BCheck the policy and procedure manual for the agency’s method.
- CChange the dressing using the method taught in nursing school.
- DAsk the patient how the dressing change has been recently done.
20A new nurse notes that the health care unit keeps a listing of patient names in a closed book behind the front desk of the nursing station so patients can be located easily. What action is most appropriate for the nurse to take?
- AMove the book to the upper ledge of the nursing station for easier access.
- BTalk with the nurse manager about the listing being a violation of the Health Insurance Portability and Accountability Act (HIPAA).
- CUse the book as needed while keeping it away from individuals not involved in patient care.
- DAsk the nurse manager to move the book to a more secluded area.
21A 17-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct?
- APrepare the organ donation form for the patient to sign while he is still oriented.
- BInstruct the patient to talk with his parents about his desire to donate his organs.
- CNotify the physician about the patient’s desire to donate his organs
- DContact the United Network for Organ Sharing after talking with the patient.
22An obstetrical nurse comes across an automobile accident. The patient seems to have a crushed upper airway, and while waiting for emergency medical services to arrive, the nurse makes a cut in the trachea and inserts a straw from her purse to provide an airway. The patient survives and has a permanent problem with his vocal cords, making it difficult to talk. Which statement is true regarding the nurse’s performance?
- AThe nurse acted appropriately and saved the patient’s life.
- BThe nurse acted within the guidelines of the Good Samaritan Law.
- CThe nurse took actions beyond those that are standard and appropriate.
- DThe nurse should have just stayed with the patient and waited for help.
23A nurse performs cardiopulmonary resuscitation (CPR) on a 92-year-old with brittle bones and breaks a rib during the procedure, which then punctures a lung. The patient recovers completely without any residual problems and sues the nurse for pain and suffering, and for malpractice. What key point will the prosecution attempt to prove?
- AThe CPR procedure was done incorrectly.
- BThe patient would have died if nothing was done.
- CThe patient was resuscitated according to policy.
- DPatients with brittle bones might sustain fractures when chest compressions are done.
24A recent immigrant who does not speak English is alert and requires hospitalization. What is the initial action that the nurse must take to enable informed consent to be obtained?
- AAsk a family member to translate what the nurse is saying.
- BNotify the health care provider that the patient doesn’t speak English.
- CRequest an official interpreter to explain the terms of consent.
- DUse hand gestures and medical equipment while explaining in English.
25A pediatric oncology nurse floats to an orthopedic trauma unit. What actions should the nurse manager of the orthopedic unit take to enable safe care to be given by this nurse?
- AProvide a complete orientation to the functioning of the entire unit.
- BDetermine patient acuity and care the nurse can safely provide.
- CAllow the nurse to choose which meal time she would like.
- DAssign nursing assistive personnel to assist her with care.
26While recovering from a severe illness, a hospitalized patient states that he wants to change his living will, which he signed nine months ago. Which response by the nurse is most appropriate?
- A“Check with your admitting health care provider whether a copy is on your chart.”
- B“Have you talked with your attorney recently about a living will?”
- C“Your living will can be changed only once each calendar year.”
- D“Let me check with someone here in the hospital who can assist you.”
27A nurse notices that his neighbor’s preschool children are often playing on the sidewalk and in the street unsupervised and repeatedly takes them back to their home and talks with the parent available, but the situation continues. What immediate action by the nurse is mandated by law?
- ATalk with both parents about safety needs of their children.
- BContact the appropriate community child protection agency.
- CTell the parents that the authorities will be contacted shortly.
- DTake pictures of the children to support the overt child abuse.
28A confused patient with a urinary catheter, nasogastric tube, and intravenous line keeps touching these needed items for care. The nurse has tried to explain to the patient that he should not touch these lines, but the patient continues. What is the best action by the nurse at this time?
- AApply restraints loosely on the patient’s dominant wrist.
- BTry other approaches to prevent the patient from touching these care items.
- CNotify the health care provider that restraints are needed immediately to maintain the patient’s safety.
- DAllow the patient to pull out lines to prove that the patient needs to be restrained.
29A patient with sepsis as a result of long-term leukemia dies 25 hours after admission to the hospital. A full code was conducted without success. The patient had a urinary catheter, an intravenous line, an oxygen cannula, and a nasogastric tube. What question is priority for the nurse to ask the family before beginning postmortem care?
- A“Do you want to assist in bathing your loved one?”
- B“Is an autopsy going to be done?”
- C“To which funeral home do you want your loved one transported?”
- D“Do you want me to remove the lines and tubes before you see your loved one?”
30Conjoined twins are in the neonatal department of the community hospital until transfer to the closest medical center. A photographer from the local newspaper gets off the elevator on the neonatal floor and wants to take pictures of the infants. What initial action should the nurse take?
- AEscort the cameraman to the neonatal unit while a few pictures are taken quietly.
- BTell the cameraman where the hospital’s public relations department is located.
- CAsk the cameraman to wait while permission is obtained from the physician.
- DAsk the cameraman how the pictures are to be used in the local newspaper.
31A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says, “I don’t understand what the big deal is. As my instructor, you are there to protect me and make sure I don’t make mistakes.” What is the best response from the nursing instructor?
- A“You are expected to perform at the level of a professional nurse.”
- B“You are expected to perform at the level of a nursing student.”
- C“You are practicing under the license of the nurse assigned to the patient.”
- D“You are expected to perform at the level of a skilled nursing assistant.”
32A nurse works full-time on the oncology unit at the hospital and works part-time on weekends giving immunizations at the local pharmacy. While giving an injection on a weekend, the nurse caused injury to the patient’s arm and is now being sued. How will the hospital’s malpractice insurance provide coverage for this nurse?
- AIt will provide coverage as long as the nurse followed all procedures, protocols, and policies correctly.
- BThe hospital’s malpractice insurance covers this nurse only during the time the nurse is working at the hospital.
- CAs long as the nurse has never been sued before this incident, the hospital’s malpractice insurance will cover the nurse.
- DThe hospital’s malpractice insurance will provide approximately 50% of the coverage the nurse will need.
33A nursing student in the final term of nursing school is overheard by a nursing faculty member telling another student that she got to insert a nasogastric tube in the emergency department while she was working as a nursing assistant. What advice is best for the nursing faculty member to give to the nursing student?
- A“Just be careful when you are doing new procedures and make sure you are following directions by the nurse.”
- B“Review your procedures before you go to work, so you will be prepared to do them if you have a chance.”
- C“The nurse should not have allowed you to insert the nasogastric tube because something bad could have happened.”
- D“You are not allowed to perform any procedures other than those in your job description even with the nurse’s permission.”
34The nurse calculates the medication dose for an infant on the pediatric unit and determines that the dose is twice what it should be. The pediatrician is contacted and says to administer the medication as ordered. What is the next action that the nurse should take? (Select all that apply.)
- ANotify the nursing supervisor.
- BCheck the chain of command policy for such situations.
- CGive the medication as ordered.
- DGive the amount calculated to be correct.
- EContact the pharmacy for clarification.
35A nurse gives an incorrect medication to a patient without doing all of the mandatory checks, but the patient has no ill effects from the medication. What actions should the nurse take after reassessing the patient? (Select all that apply.)
- ANotify the health care provider of the situation.
- BDocument in the patient’s medical record that an occurrence report was filed.
- CDocument in the patient’s medical record why the omission occurred.
- DDiscuss what happened with all of the other nurses and staff on the unit.
- EContinue to monitor the patient for any untoward effects from the medication.
- FSend an occurrence report to risk management after completing it.
36The nurse hears a physician say to the charge nurse that he doesn’t want that same nurse caring for his patients because she is stupid and won’t follow his orders. The physician also writes on his patient’s medical records that the same nurse, by name, is not to care for any of his patients because of her incompetence. What component(s) of defamation has the physician committed? (Select all that apply.)
- ASlander
- BInvasion of privacy
- CLibel
- DAssault
- EBattery
37A patient has just been told that he has approximately six months to live and asks about advance directives. Which statements by the nurse give the patient correct information? (Select all that apply.)
- A“You have the right to refuse treatment at any time.”
- B“If you want certain procedures or actions taken or not taken, and you might not be able to tell anyone at the time, you need to complete documents ahead of time that give your health care provider this information.”
- C“You will be resuscitated at any time to allow you the longest length of survival.”
- D“You might want to think about choosing someone who will make medical decisions for you in the event that you are unable to make your desires known.”
- E“We will get someone who knows the state’s guidelines to assist you in setting up your living will.”
- F“If you travel to another state, your living will should cover your wishes.”
38A patient’s condition is slowly deteriorating. What actions should the nurse take to provide the best care possible? (Select all that apply.)
- AAllow the nursing student to receive verbal orders from the physician in the room while the nurse is in the medication area down the hall.
- BDocument the patient’s status changes in the medical record in a timely manner.
- CDocument that the health care provider has been notified of the specific patient status, including date and time that messages were left.
- DCheck the chart for frequent orders.
- EOmit charting what the health provider’s response is to notification of the patient’s status change.
39Nurses who make the best communicators
- ADevelop critical thinking skills.
- BLike different kinds of people.
- CLearn effective psychomotor skills.
- DMaintain perceptual biases.
40A nurse believes that the nurse-patient relationship is a partnership, and that both are equal participants. Which term should the nurse use to describe this belief?
- ACritical thinking
- BAuthentic
- CMutuality
- DAttend
41A nurse wants to present information about flu immunizations to the elderly in the community. Which type of communication should the nurse use?
- AInterpersonal
- BPublic
- CTranspersonal
- DSmall group
42Which technique will be most successful in ensuring effective communication? The nurse uses
- AInterpersonal communication to change negative self-talk to positive self-talk.
- BSmall group communication to present information to an audience.
- CIntrapersonal communication to build strong teams.
- DTranspersonal communication to enhance meditation.
43A nurse is standing beside the patient’s bed.
Nurse: How are you doing?
Patient: I don’t feel good.
In this situation, which element is the feedback?- ANurse
- BPatient
- CHow are you doing?
- DI don’t feel good.
44A nurse is sitting at the patient’s bedside taking a nursing history. Which zone of personal space is the nurse using?
- AIntimate
- BPersonal
- CSocial
- DPublic
45A smiling patient angrily states, “I will not cough and deep breathe.” How will the nurse interpret this finding?
- AThe patient’s personal space was violated.
- BThe patient’s affect is inappropriate.
- CThe patient’s vocabulary is poor.
- DThe patient’s denotative meaning is wrong.
46The nurse asks a patient where the pain is, and the patient responds by pointing to the area of pain. Which form of communication did the patient use?
- AVerbal
- BNonverbal
- CIntonation
- DVocabulary
47A patient has been admitted to the hospital numerous times. The nurse asks the patient to share a personal story about the care that has been received. Which interaction is the nurse using?
- ANarrative
- BSocializing
- CNonjudgmental
- DSBAR
48Before meeting the patient, a nurse talks to other caregivers about the patient. The nurse is in which phase of the helping relationship?
- APre-interaction
- BOrientation
- CWorking
- DTermination
49During the initial home visit, a home health nurse lets the patient know that the visits are expected to end in about a month. The nurse is in which phase of the helping relationship?
- APre-interaction
- BOrientation
- CWorking
- DTermination
50A nurse and patient take action to meet health-related goals. The nurse is in which phase of the helping relationship?
- APre-interaction
- BOrientation
- CWorking
- DTermination
51A nurse uses SBAR during hand-offs. The purpose of SBAR is to
- AUse common courtesy.
- BEstablish trustworthiness.
- CPromote autonomy.
- DStandardize communication.
52A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Using the SBAR, which piece of data will the nurse use for B?
- AHaving chest pain
- BPulse rate of 108
- CHistory of angina
- DOxygen is needed.
53A patient has trouble speaking words, and the patient’s speech is garbled. Which nursing diagnosis is most appropriate for this patient?
- AHopelessness
- BImpaired verbal communication
- CHearing loss
- DSelf-care deficit
54Which person is the best referral for a patient who speaks a foreign language?
- AA family member
- BA speech therapist
- CAn interpreter
- DA mental health nurse specialist
55A nurse is using SOLER to facilitate active listening. Which technique should the nurse use for R?
- ARelax
- BRespect
- CReminisce
- DReassure
56An elderly patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication?
- ASpeak clearly and loudly
- BTurn off the television.
- CChew gum
- DUse at least 14-point print.
57When making rounds, the nurse finds a patient who is not able to sleep because of surgery in the morning. Which therapeutic response is most appropriate?
- A“It will be okay. Your surgeon will talk to you in the morning.”
- B“Why can’t you sleep? You have the best surgeon in the hospital.”
- C“Don’t worry. The surgeon ordered a sleeping pill to help you sleep.”
- D“It must be difficult not to know what the surgeon will find. What can I do to help?”
58Which situation will cause the nurse to intervene and follow up on the nurse aide’s behavior?
- AThe nurse aide is calling the older adult patient “honey.”
- BThe nurse aide is facing the older adult patient when talking
- CThe nurse aide cleans the older adult patient’s glasses
- DThe nurse aide allows time for the older adult patient to respond.
59A confused older adult patient is wearing thick glasses and a hearing aid. Which intervention is priority to facilitate communication?
- AFocus on tasks to be completed.
- BAllow time for the patient to respond.
- CLimit conversations with the patient.
- DUse gestures and other nonverbal cues.
60The staff is having a hard time getting an older adult patient to communicate. Which technique should the nurse suggest the staff use?
- AAllow the patient to reminisce
- BTry changing topics often.
- CInvolve only the patient in conversations.
- DAsk the patient for explanations
61The patient that will cause the greatest communication concerns for a nurse is the patient who is
- AAlert, has strong self-esteem, and is hungry.
- BOriented, pain free, and blind.
- CCooperative, depressed, and hard of hearing.
- DDyspneic, has a tracheostomy, and is anxious.
62A patient is aphasic, and the nurse notices that the patient’s hands shake intermittently. Which nursing action is most appropriate to facilitate communication?
- AUse a picture board.
- BUse pen and paper
- CUse an interpreter.
- DUse a hearing aid.
63The nurse using critical thinking to enhance communication with patients is one who
- AShows sympathy appropriately.
- BUses automatic responses fluently.
- CSelf-examines personal communication skills.
- DDemonstrates passive remarks accurately.
64A patient says, “You are the worst nurse I have ever had.” Which response by the nurse is the most assertive?
- A“If I were you, I’d feel grateful for a nurse like me.”
- B“I feel uncomfortable hearing that statement.”
- C“How can you say that when I have been checking on you regularly?”
- D“You shouldn’t say things like that, it is not right.”
65Which critical thinking standards should the nurse use to ensure sound effective communication with patients? (Select all that apply.)
- AFaith
- BSupportiveness
- CSelf-confidence
- DHumility
- EIndependent attitude
- FSpiritual expression
66Which types of patients can cause challenging communication situations? (Select all that apply.)
- AA male patient who is cooperative with treatments
- BA female patient who is outgoing and flirty
- CAn older adult patient who is demanding
- DAn elderly patient who can clearly see small print
- EA teenager frightened by the prospect of impending surgery
- FA child who is developmentally delayed
67 A nurse is asked about the goal of patient education. What is the nurse’s best response? The goal of educating others is to help people
- AMeet standards of the Nurse Practice Act.
- BAchieve optimal levels of health.
- CBecome dependent on the health care team.
- DProvide self-care only in the hospital.
68A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which purpose of patient education is the nurse fulfilling?
- ARestoration of health
- BCoping with impaired functions
- CPromotion of health and illness prevention
- DHealth analogies
69A nurse provides teaching about coping with long-term impaired functions. Which situation serves as the best example?
- ATeaching a family member to give medications through the patient’s permanent gastric tube
- BTeaching a woman who recently had a hysterectomy about her pathology reports
- CTeaching expectant parents about physical and psychological changes in childbearing women
- DTeaching a teenager with a broken leg how to use crutches
70Which statement indicates that the nurse has a good understanding of teaching/learning?
- A“Teaching and learning can be separated.”
- B“Learning is an interactive process that promotes teaching.”
- C“Learning consists of a conscious, deliberate set of actions designed to help the teacher.”
- DTeaching is most effective when it responds to the learner’s needs.”
71Which action best indicates that learning has occurred?
- AA nurse presents information about diabetes.
- BA patient demonstrates how to inject insulin.
- CA family member listens to a lecture on diabetes.
- DA primary care provider hands a diabetes pamphlet to the patient.
72A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include?
- AThe nurse is the center of the health care team
- BIf you still do not understand, ask again.
- CAsk a nurse to be your advocate or supporter
- DInappropriate medical tests are the most common mistakes.
73A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. In this situation, which element represents feedback?
- AThe nurse
- BThe patient
- CThe nurse teaching about healthy food choices
- DThe patient stating that eating yogurt is better than eating cake
74While preparing a teaching plan, the nurse described what the learner will be able to accomplish after the teaching session. Which action did the nurse complete?
- ADeveloped learning objectives
- BProvided positive reinforcement
- CImplemented interpersonal communication
- DPresented facts and knowledge
75A student nurse learns that a normal adult heartbeat is 60 to 100 beats/minute. In which domain did learning take place?
- AKinesthetic
- BCognitive
- CAffective
- DPsychomotor
76A nurse wants the patient to begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning?
- ALecture
- BDemonstration
- CRole play
- DQuestion and answer session
77When the nurse describes a patient’s perceived ability to successfully complete a task, which term should the nurse use?
- ASelf-efficacy
- BMotivation
- CAttentional set
- DActive participation
78A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage?
- AEncourage independent learning.
- BUse discussion throughout the teaching session.
- CApply a bandage to a doll’s ear.
- DDevelop a problem-solving scenario.
79Which factors should the nurse assess to determine a patient’s ability to learn?
- ADevelopmental capabilities and physical capabilities
- BSociocultural background and motivation
- CPsychosocial adaptation to illness and active participation
- DStage of grieving and overall physical health
80A nurse is preparing to teach a patient about heart failure. Which environment is best for patient learning?
- AA darkened, quiet room
- BA well-lit, ventilated room
- CA private room at 85° F temperature
- DA group room for 10 to 12 patients with heart failure
81Which situation indicates to the nurse that the patient is ready to learn?
- AA patient has sufficient upper body strength to move from a bed to a wheelchair.
- BA patient has the ability to grasp and apply the elastic bandage.
- CA patient with a below-the-knee amputation is motivated about how to walk with assistive devices.
- DA patient has normal eyesight to identify the markings on a syringe and coordination to handle a syringe.
82A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? During the teaching process, what should the nurse do?
- AAssess all sources of data.
- BIdentify that it is the same as the nursing process.
- CPerform nursing care therapies.
- DFocus on a patient’s learning needs.
83Which nursing action is most appropriate for assessing a patient’s learning needs?
- AAssess the patient’s total health care needs.
- BAssess the patient’s health literacy.
- CAssess all sources of patient data.
- DAssess the goals of patient care.
84A nurse is going to teach a patient about hypertension. Which action should the nurse implement first?
- ASet mutual goals for knowledge of hypertension.
- BTeach what the patient wants to know about hypertension.
- CAssess what the patient already knows about hypertension.
- DEvaluate the outcomes of patient education for hypertension.
85A patient had a stroke and must use a cane for support. A nurse is preparing to teach the patient about the cane. Which learning objective/outcome is most appropriate?
- AThe patient will walk to the bathroom and back to bed using a cane.
- BThe patient will understand the importance of using a cane.
- CThe patient will learn how to use a cane.
- DThe patient will know the correct use of a cane.
86Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)?
- AThe patient will administer epinephrine.
- BThe patient will identify the main ingredients in several foods.
- CThe patient will list the side effects of epinephrine.
- DThe patient will learn about food labels.
87After a teaching session on taking blood pressures, the nurse tells the patient, “You took that blood pressure like an experienced nurse.” What type of reinforcement did the nurse use?
- AMaterial
- BActivity
- CSocial
- DEntrusting
88A patient with heart failure is learning to reduce salt in the diet. When would be the best time for the nurse to address this topic?
- AAt bedtime, when the patient is relaxed
- BAt lunchtime while the nurse is preparing the food tray
- CAt bath time, when the nurse is cleaning the patient
- DAt medication time, when the nurse is administering patient medication
89A nurse is teaching a patient who has low health literacy about chronic obstructive pulmonary disease (COPD) while giving COPD medications. Which technique is most appropriate for the nurse to use?
- AUse complex analogies to describe COPD
- BInclude the most important information on COPD at the beginning of the session
- CAsk for feedback to assess understanding of COPD at the end of the session.
- DOffer pamphlets about COPD written at the eighth grade level with large type
90A nurse is teaching a culturally diverse patient about nutritional needs. What must the nurse do first before starting the teaching session?
- AObtain pictures of food.
- BGet an interpreter.
- CEstablish a rapport.
- DRefer to a dietitian
91A nurse is teaching an older adult patient about strokes. Which teaching technique is most appropriate for the nurse to use?
- AUse a pamphlet about strokes with large font in blues and greens.
- BSpeak in a high tone of voice to describe strokes.
- CBegin and end each teaching session with the most important information about strokes.
- DProvide specific information about strokes in frequent, large amounts
92A patient has been taught how to cough and deep breathe. Which evaluation method is most appropriate?
- AReturn demonstration
- BComputer instruction
- CVerbalization of steps
- DCloze test
93A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions. What is the nurse’s next action?
- ARefer to a mental health specialist.
- BRefer to an ostomy specialist.
- CRefer to a dietitian.
- DRefer to a wound care specialist.
94A nurse has taught a patient about healthy eating habits. Which learning objective/outcome is most appropriate for the affective domain?
- AThe patient will state three facts about healthy eating.
- BThe patient will identify two foods for a healthy snack
- CThe patient will verbalize the value of eating healthy.
- DThe patient will cook a meal with low-fat oil.
95A nurse is assessing the ability to learn of a patient who has recently experienced a stroke. Which question/statement will best assess the patient’s ability to learn?
- A“What do you want to know about strokes?”
- B"On a scale from 1 to 10, tell me where you rank your desire to learn."
- C“Do you feel strong enough to perform the tasks I will teach you?”
- D“Please read this handout and tell me what it means.”
96A nurse is preparing to teach a kinesthetic learner about exercise. Which technique should the nurse use?
- ALet the patient touch and use the exercise equipment.
- BProvide the patient with pictures of the exercise equipment.
- CLet the patient listen to a podcast about the exercise equipment.
- DProvide the patient with a case study about the exercise equipment.
97Which statements by the nurse indicate a good understanding of patient education/teaching? (Select all that apply.)
- A“Patient education is a standard for professional nursing practice.”
- B“Patient teaching falls within the scope of nursing practice.”
- C“Patient education is an essential component of safe, patient-centered care.”
- D“Patient education is not effective with children.”
- E“Patient teaching can increase health care costs.”
- F“Patient teaching should be documented in the chart.”
98Which situation will cause the nurse to postpone a teaching session? (Select all that apply.)
- AThe patient is mildly anxious.
- BThe patient is fatigued.
- CThe patient is asking questions.
- DThe patient is hurting.
- EThe patient is febrile (high fever).
- FThe patient is in the acceptance phase.
99What does the abbreviation "NPO" mean?
- Atake medication at night
- Bas needed
- CNothing by mouth
- DNew Prescription Order
100A nurse preceptor is working with a student nurse. Which behavior by the student nurse will require the nurse preceptor to intervene?
- AThe student nurse reviews the patient’s medical record.
- BThe student nurse reads the patient’s plan of care.
- CThe student nurse shares patient information with a friend.
- DThe student nurse documents medication administered to the patient.
101A nurse prepared an audiotaped exchange with another nurse of information about a patient. Which action did the nurse complete? The nurse completed a
- AReport
- BRecord
- CConsultation
- DReferral
102Which situation best indicates that the nurse has a good understanding regarding auditing and monitoring of patients’ health records?
- AThe nurse determines the degree to which standards of care are met by reviewing patients’ health records.
- BThe nurse realizes that care not documented in patients’ health records still qualifies as care provided
- CThe nurse knows that reimbursement is based on the diagnosis-related groups documented in patients’ records.
- DThe nurse compares data in patients’ records to determine whether a new treatment had better outcomes than the standard treatment.
103After providing care, a nurse charts in the patient’s record. Which entry should the nurse document?
- AAppears restless when sitting in the chair
- BDrank adequate amounts of water
- CApparently is asleep with eyes closed
- DSkin pale and cool
104 A nurse has provided care to a patient. Which entry should the nurse document in the patient’s record?
- A“Patient seems to be in pain and states, ‘I feel uncomfortable.’”
- BStatus unchanged, doing well
- CLeft abdominal incision 1 inch in length without redness, drainage, or edema
- DPatient is hard to care for and refuses all treatments and medications. Family present.
105A preceptor is working with a new nurse on documentation. Which situation will cause the preceptor to intervene?
- AThe new nurse uses a black ink pen to chart.
- BThe new nurse charts consecutively on every other line.
- CThe new nurse ends each entry with signature and title.
- DThe new nurse keeps the password secure.
106 A nurse is charting on a patient’s record. Which action is most accurate legally?
- ACharts legibly
- BStates the patient is belligerent
- CUses correction fluid to correct error
- DWrites entry for another nurse
107A nurse wants to integrate all pertinent patient information into one record, regardless of the number of times a patient enters the health care system. Which term should the nurse use to describe this system?
- AElectronic medical record
- BElectronic health record
- CElectronic charting record
- DElectronic problem record
108A nurse has taught the patient how to use crutches. The patient went up and down the stairs using crutches with no difficulties. Which information will the nurse use for the “I” in PIE charting?
- APatient went up and down stairs
- BDeficient knowledge regarding crutches
- CDemonstrated use of crutches
- DUsed crutches with no difficulties
109 A nurse is using the source record and wants to find the daily weights. Where should the nurse look?
- ADatabase
- BMedical history and examination
- CProgress notes
- DGraphic sheet and flow sheet
110 A nurse is a member of an interdisciplinary team that uses critical pathways. According to the critical pathway, on day 2 of the hospital stay, the patient should be sitting in the chair. It is day 3, and the patient cannot sit in the chair. What should the nurse do?
- AFocus charting using the DAR format.
- BAdd this data to the problem list.
- CDocument the variance in the patient’s record.
- DReport a positive variance in the next interdisciplinary team meeting
111A nurse needs to begin discharge planning for a patient admitted with pneumonia and a congested cough. When is the best time the nurse should start discharge planning for this patient?
- AUpon admission
- BRight before discharge
- CAfter the congestion is treated
- DWhen the primary care provider writes the order
112A patient is being discharged home. Which information should the nurse include?
- AAcuity level
- BCommunity resources
- CStandardized care plan
- DKardex
113A home health nurse is preparing for an initial home visit. Which information should be included in the patient’s home care medical record?
- ANursing process form
- BStep-by-step skills manual
- CA list of possible procedures
- DReports to third party payers
114A nurse in a long-term care setting that is funded by Medicare and Medicaid is completing standardized protocols for assessment and care planning and for meeting quality improvement within and across facilities. Which task did the nurse just complete?
- AA focused assessment/specific body system
- BThe Resident Assessment Instrument/Minimum Data Set
- CAn admission assessment and acuity level
- DAn intake assessment form and auditing phase
115A nurse is giving a hand-off report to the oncoming nurse. Which information is critical for the nurse to report?
- AThe patient had a good day with no complaints.
- BThe family is demanding and argumentative.
- CThe patient has a new pain medication, Lortab.
- DThe family is poor and had to go on welfare.
116 A new nurse asks the preceptor why a change-of-shift report is important since care is documented in the chart. What is the preceptor’s best response?
- A“A hand-off report provides an opportunity to share essential information to ensure patient safety and continuity of care.”
- B“A change-of-shift report provides the oncoming nurse with data to help set priorities and establish reimbursement costs.”
- C“A hand-off report provides an opportunity for the oncoming nurse to ask questions and determine research priorities.”
- D“A change-of-shift report provides important information to caregivers and develops relationships within the health care team.”
117A nurse is preparing a change-of-shift report for a patient who had chest pain. Which information is critical for the nurse to include?
- APupils equal and reactive to light
- BThe family is a “pain”
- CHad poor results from the pain medication
- DSharp pain of 8 on a scale of 1 to 10
118Which situation will require the nurse to obtain a telephone order?
- AAs the nurse and primary care provider leave a patient’s room, the primary care provider gives the nurse an order.
- BAt 0100, a patient’s blood pressure drops from 120/80 to 90/50 and the incision dressing is saturated with blood.
- CAt 0800, the nurse and primary care provider make rounds and the primary care provider tells the nurse a diet order.
- DA nurse reads an order correctly as written by the primary care provider in the patient’s medical record.
119A nurse obtained a telephone order from a primary care provider for a patient in pain. Which chart entry should the nurse document?
- A12/16/20XX 0915 Tylenol 3, 2 tablets, every 6 hours for incisional pain. VO Dr. Day/J. Winds, RN, read back.
- B12/16/20XX 0915 Tylenol 3, 2 tablets, every 6 hours for incisional pain. TO J. Winds, RN, read back.
- C12/16/20XX 0915 Tylenol 3, 2 tablets, every 6 hours for incisional pain. TO Dr. Day/J. Winds, RN, read back.
- D12/16/20XX 0915 Tylenol 3, 2 tablets, every 6 hours for incisional pain. TO J. Winds, RN.
120A nurse has taught the staff about informatics. Which statement indicates that the staff needs more education?
- AIf a nurse has computer competency, the nurse is competent in informatics.
- BTo be proficient in informatics, a nurse should be able to discover, retrieve, and use information in practice.
- CA nurse needs to know how to acquire, critique, and apply scientific evidence from literature databases.
- DNursing informatics integrates nursing science, computer science, and information science to manage and communicate information in nursing practice.
121A hospital is using a computer system that allows all health care providers to use a protocol system to document the care they provide. Which type of system/design will the nurse be using?
- AClinical decision support system
- BNursing process design
- CCritical pathway design
- DComputerized provider order entry system
122A nurse wants to reduce data entry errors on the computer system. Which behavior should the nurse implement?
- AUse the same password all the time.
- BShare password with only one other staff member.
- CPrint out and review computer nursing notes at home.
- DChart on the computer immediately after care is provided.
123 Which entry will require follow-up by the nurse manager?
0800 Patient states, “Fell out of bed.” Patient found lying by bed on the floor. Legs equal in length bilaterally with no distortion, pedal pulses strong, leg strength equal and strong, no bruising or bleeding. Neuro checks within normal limits. States, “Did not pass out.” Assisted back to bed. Call bell within reach. Bed monitor on.
——————-Jane More, RN
0810 Notified primary care provider of patient’s status. New orders received. ——————-Jane More, RN
0815 Portable x-ray of L hip taken in room. States, “I feel fine.” ——————-Jane More, RN
0830 Incident report completed and placed on chart.
——————-Jane More, RN- A0800
- B0810
- C0815
- D0830
124A patient has a diagnosis of pneumonia. Which entry should the nurse chart to help with financial reimbursement?
- AUsed incentive spirometer to encourage coughing and deep breathing. Lung congested upon auscultation in lower lobes bilaterally. Pulse ox 86%. Oxygen per nasal cannula applied at 2 L/min per standing order.
- BCooperative, patient coughed and deep breathed using a pillow as a splint. Stated, “felt better.” Finally, patient had no complaints.
- CBreathing without difficulty. Sitting up in bed watching TV. Had a good day.
- DStatus unchanged. Remains stable with no abnormal findings. Checked every 2 hours.
125A nurse is teaching the staff about health care reimbursement. Which information should the nurse include?
- ASentinel events help determine reimbursement issues for health care.
- BHome health, long-term care, and hospital nurses’ documentation can affect reimbursement for health care.
- CA clinical information system must be installed by 2014 to obtain health care reimbursement.
- DHIPAA is the basis for establishing reimbursement for health care.
126A nurse is discussing the advantages of standardized documentation forms in the nursing information system. Which advantage should the nurse describe?
- AVaried clinical databases
- BReduced errors of omission
- CIncreased hospital costs
- DMore time to read charts
127Which behaviors indicate that the student nurse has a good understanding of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA)? (Select all that apply.)
- AWrites the patient’s room number and date of birth on a paper for school
- BPrints/copies material from the patient’s health record for a graded care plan
- CReviews assigned patient’s record and another unassigned patient’s record
- DReads the progress notes of assigned patient’s record
- EGives a change-of-shift report to the oncoming nurse about the patient
- FDiscusses patient care with the hospital volunteer
128Identify the purposes of a health care record. (Select all that apply.)
- ACommunication
- BLegal documentation
- CReimbursement
- DEducation
- EResearch
- FNursing process
129What does the abbreviation "PRN" mean?
- APre-Registered Nurse
- BAs Needed
- CPlan, Revise, New
- DPlease Refrain from Neglect
130During a teaching session, the nurse tells a patient with a recent neck injury that damage to the nerves is comparable to a water hose that has been pinched off. During this teaching session, the nurse is using the process of:
- Aanalogy
- Bdiscovery
- Crole playing
- Ddemonstration
Información
- Descripción
- Covers Chapters 22-26.... Note chapter 26 may have information that may not be necessary for the exam, but could be for the HESI.
- Autor
- Matthew Crislip
- Idioma
- English
- Visitas
- 30
- Valoración
- Aún sin valoraciones Valora este test